Character Reference printable pdf download

Character Reference

APPLICANT’S NAME:

Character Reference

MEMBERSHIP NO:

(EduCare applicants will need one Character

Reference completed by a teacher)

FOR OFFICE USE ONLY

THIS APPLICANT IS APPLYING TO BE AN AU PAIR IN AMERICA. PLEASE ANSWER ALL QUESTIONS HONESTLY AND

RETURN PROGRAM (continued)

COMPLETE THIS FORM USING BLACK INK. A LOCAL REPRESENTATIVE WILL CONTACT YOU TO CONFIRM THIS

REFERENCE. IF YOU ARE UNABLE TO WRITE IN ENGLISH, PLEASE COMPLETE THE REFERENCE IN YOUR NATIVE

LANGUAGE. RELATIVES SHOULD NOT COMPLETE THIS FORM. THANK YOU!

How do you know the applicant (employer, family friend, teacher, etc)?

How long have you known the applicant?

How would you describe the applicant’s personality and character?

If you have taught the applicant, please provide the course name and describe the applicant’s particular academic interests and abilities:

Please give your opinion on how the applicant handles stressful situations:

Please give your opinion on how the applicant has adapted to new circumstances / new cultures:

To the best of your knowledge, has the applicant ever been convicted of or charged with a criminal offence?

YES

If yes, give details:

To the best of your knowledge, does the applicant have any health or family problems?

YES

If yes, give details:

Why would you recommend this applicant as an au pair in America? Please provide detailed reasons:

Please provide any additional information about the applicant that you think might be helpful to a prospective host family:

REFEREE’S DETAILS

Name (please print):

Occupation:

Telephone Number:

Mobile/Cell Number:

Best time(s) to call:

Dates in the near future

when you will not be

YES

Do you speak English?

contactable (eg vacation):

Signature: ____________________________________________________

Date: _________________________________________________________

Character Reference